The public-health crisis that Democrats won't see

By opposing safer nicotine products, Democratic elected officials contribute to the deaths and disease caused by smoking cigarettes.

Photo by LexScope on Unsplash

Democrats like to think of themselves as the party that embraces science, innovation and evidence-based policy. On issues such as climate change and vaccines, they’re mostly right.

That’s not the case when it comes to smoking. Cigarette smoking kills about 480,000 Americans a year. That’s more deaths than the CDC attributed to COVID-19 in 2021, the worst year of the epidemic.

Democrats are making the problem worse.

That’s because the majority of the party’s governors, mayors and congressional leaders steadfastly oppose safer nicotine products — including e-cigarettes and nicotine pouches — that represent the single best way to reduce the deaths and disease caused by smoking.

It’s shocking, really, especially because the harms caused by smoking fall disproportionally on the marginalized groups – lower income, less educated, LGBTQ, Native Americans – who Democrats claim to care about.

“It’s a complete class issue,” says Lindsay Lewis, chief executive of the Progressive Policy Institute, who has become an outlier among Democrats by supporting safer alternatives.

There’s an opportunity here for Democrats, especially those running for office this year: They can and should break with the party orthodoxy to support what’s called tobacco harm reduction – that is, the idea that if people who smoke can’t or won’t quit, they should be encouraged to switch to the safer alternatives like vapes and pouches.

Harm reduction works. If, like most people, you haven’t paid close attention, you should know that there’s growing evidence that nicotine vapes and pouches can benefit public health. Vapes and pouches are not perfectly safe but they are far safer than lethal, combustible cigarettes. They’re also more effective than FDA-approved nicotine gums and patches at helping people to quit smoking, according to the most recent data from the Centers for Disease Control and the widely-respected Cochrane Review. It’s no wonder that tens of millions of former smokers have bought vapes on the black or gray market and used them to quit.

In the UK, New Zealand and Sweden, where governments have mostly embraced the safer nicotine products, smoking rates are falling fast. In Japan, cigarette sales declined by more than 50 percent – yes, 50 percent – after the introduction of a smoke-free device that releases nicotine by heating tobacco instead of burning it; smokers get a nicotine fix without breathing in the toxic chemicals found in cigarette smoke.

“We could actually end the use of cigarettes,” says Lewis. “I mean, completely end smoking. It doesn’t come from prohibition. It comes from embracing these new products.”

Instead, Democrats continue to assail e-cigarettes and pouches. Five states led by Democrats — California, New York, New Jersey, Massachusetts and Rhode Island — have banned flavored e-cigarettes. So have cities including Philadelphia, Minneapolis and Denver. Party leaders in Congress call for a national ban on flavored vapes.

They do so in the name of protecting kids. U.S. Sen. Dick Durbin, an Illinois Democrat, accused the FDA of “unleashing a wave of disease and addiction on America’s children” when the agency authorized Juul to sell e-cigarettes last year. When FDA said last week—at long last—that it would consider authorizing flavored vapes, the Campaign for Tobacco-Free Kids complained, predictably, that flavoirs attract youth. Its website continues to talk up a non-existent “nationwide crisis of youth addiction.”

No one wants kids to use tobacco products. But the vaping epidemic of the late 2010s has come and gone. Teen vaping has dropped by nearly 70 percent from its peak. Teen use of all tobacco products, including cigarettes, has fallen to a 25-year low. What’s more, federal law already prohibits anyone under 21 from buying tobacco products, including e-cigarettes and pouches.

By focusing myopically on kids, Democratic leaders and the anti-tobacco advocacy groups are leaving adults who smoke behind. Most of the 28 million Americans who smoke have tried to quit, usually multiple times.

Those who, like me, lean libertarian would have long ago permitted adults to access safer nicotine products. Bodily autonomy means that each of us has the fundamental right to decide what to consume (or not), whether to accept medical treatment (or not), with whom to have sex with (or not) and how long to go on living (or not). It’s a fundamental cornerstone of individual freedom.

But you don’t have to be a libertarian to believe that adults should be able to use vapes and pouches.

Back in 2021, 15 past presidents of the Society for Research on Nicotine and Tobacco, the leading organization dedicated to tobacco and nicotine research, urged policymakers, the health community and the media to rethink their approach to e-cigarettes. “The potential lifesaving benefits of e-cigarettes for adult smokers deserve attention equal to the risks to youths,” they wrote.

It was a polite rebuke to the prohibitionist camp.

“Nobody’s paid any attention,” laments Ken Warner, a former dean of the University of Michigan School of Public Health and lead author of the essay, which ran in the American Journal of Public Health.

Just look what happened last November in Denver. Voters approved a law banning the sale of flavored tobacco, including e-cigarettes, with more than 70 percent favoring the measure. Denver Mayor Mike Johnston, a progressive Democrat, backed the ban.

It was not a fair fight. Michael Bloomberg, the billionaire former mayor of New York City, who has funded a global crusade against e-cigarettes, gave more than $5 million to a political action committee called Denver Kids vs. Big Tobacco that favored the ban.

Bloomberg’s vast wealth has had an immense influence on tobacco politics. His charitable foundation, Bloomberg Philanthropies, has spent more than $1.6 billion to fight tobacco use in the U.S. and globally since 2005. His foundation is the biggest single donor to the Campaign for Tobacco-Free Kids. Bloomberg donated nearly $100 million to Democrats during the 2024 election cycle, after spending more than $1 billion on his own ill-fated presidential campaign in 2020. He is Trump-like in his arrogance.

Bloomberg and Matthew Myers, the longtime executive director of the Campaign for Tobacco-Free Kids, “have networks of influence and trust that have developed over 20 or 30 years,” says David Abrams, a professor of global health at New York University. “Talk about the deep state? This is a deep state.”

Says Clive Bates, a British harm-reduction advocate: “Bloomberg will reach the end of his days responsible for thousands, maybe millions, of deaths and untold misery.”

Only a handful of Democrats have bucked party elders on tobacco. Among them are Lewis of the Progressive Policy Institute; Tom Miller, who served as Iowa’s attorney general for 40 years; and North Carolina Rep. Don Davis, who worked in the tobacco fields as a young man.

Lewis embraced tobacco harm reduction after switching from cigarettes to a device that heats but does not burn tobacco. He bought it in Italy about a decade ago and wondered why it was unavailable to Americans who smoke. “This is really personal to me,” he says. He has held a series of dinners about harm reduction, introducing scientists and researchers to congressional staff.

Miller, the longest-serving state attorney general in U.S. history, is a liberal Democrat who fought the tobacco companies for decades. While serving on the board of an anti-tobacco nonprofit now called the Truth Initiative, he spent time with researchers, including NYU’s David Abrams, and came to believe that “if you go to real scientists, the evidence is very one-sided in favor of harm reduction.”

For his part, Davis co-chairs the Congressional Tobacco Harm Reduction Caucus with Rep. Guy Reschenthaler, a Pennsylvania Republican. The group has fewer than two dozen members, most of them Republicans.

Davis declined to be interviewed but told me by email that people who smoke should be encouraged to “transition to less harmful, non-combustible alternatives.” A former air force officer, Davis has asked the Pentagon to provide the safer products to service members who smoke.

Why Democratic elites won’t face up to the damage by cigarette smoking is a bit of a mystery. The problem, I think, is that they rarely come into contact with the smokers who could benefit from switching to vapes or pouches.

Those smokers tend to be people who didn’t finish high school or attend college, people with mental health issues and those facing stress because they come from marginalized groups, according to CDC data. By contrast, the anti-vaping movement took hold in the mid-2010s in the tonier, left-leaning precincts of Manhattan and Silicon Valley where influential parents became alarmed when their teens started to vape.

Lewis told me: “It is a poster-child issue that shows you how government is not doing its job for working-class people.”

It’s also a classic case of the government telling us what we can and cannot put into our bodies. That’s never a good thing.